Neonatal mortality

新生儿死亡率
  • 文章类型: Journal Article
    新生儿死亡率预测评分可以帮助临床医生及时做出临床决定,通过在需要时促进早期入院来挽救新生儿的生命。它还可以帮助减少不必要的录取。
    该研究旨在开发和验证阿姆哈拉地区公立医院28天内新生儿死亡的预后风险评分,埃塞俄比亚。
    该模型是在2021年7月至2022年1月期间,在六家医院使用经过验证的新生儿近错过评估量表和365名新生儿的前瞻性队列开发的。使用接收器工作特性曲线下的面积评估模型的准确性,校准带,和乐观的统计数据。使用500次重复自举技术进行内部验证。决策曲线分析用于评估模型的临床实用性。
    总共,365名新生儿中有63人死亡,新生儿死亡率为17.3%(95%CI:13.7-21.5)。确定了六个潜在的预测因子并将其包括在模型中:怀孕期间的贫血,妊娠高血压,胎龄小于37周,出生窒息,5分钟Apgar评分小于7,出生体重小于2500g。模型的AUC为84.5%(95%CI:78.8-90.2)。通过内部效度解释过拟合的模型预测能力为82%。决策曲线分析显示较高的临床效用表现。
    新生儿死亡率预测评分有助于早期发现,临床决策,and,最重要的是,及时对高危新生儿进行干预,最终拯救埃塞俄比亚的生命。
    主要发现:在埃塞俄比亚测试的新生儿死亡率预后风险评分具有很高的准确性,决策曲线分析显示临床效用表现增加。增加的知识:这里开发的工具可以帮助医疗保健提供者识别高危新生儿并做出及时的临床决定以挽救生命。对政策和行动的全球健康影响:这些发现有可能在当地情况下应用,以识别高风险新生儿并做出可以提高儿童存活率的治疗决定。
    UNASSIGNED: A neonatal mortality prediction score can assist clinicians in making timely clinical decisions to save neonates\' lives by facilitating earlier admissions where needed. It can also help reduce unnecessary admissions.
    UNASSIGNED: The study aimed to develop and validate a prognosis risk score for neonatal mortality within 28 days in public hospitals in the Amhara region, Ethiopia.
    UNASSIGNED: The model was developed using a validated neonatal near miss assessment scale and a prospective cohort of 365 near-miss neonates in six hospitals between July 2021 and January 2022. The model\'s accuracy was assessed using the area under the receiver operating characteristics curve, calibration belt, and the optimism statistic. Internal validation was performed using a 500-repeat bootstrapping technique. Decision curve analysis was used to evaluate the model\'s clinical utility.
    UNASSIGNED: In total, 63 of the 365 neonates died, giving a neonatal mortality rate of 17.3% (95% CI: 13.7-21.5). Six potential predictors were identified and included in the model: anemia during pregnancy, pregnancy-induced hypertension, gestational age less than 37 weeks, birth asphyxia, 5 min Apgar score less than 7, and birth weight less than 2500 g. The model\'s AUC was 84.5% (95% CI: 78.8-90.2). The model\'s predictive ability while accounting for overfitting via internal validity was 82%. The decision curve analysis showed higher clinical utility performance.
    UNASSIGNED: The neonatal mortality predictive score could aid in early detection, clinical decision-making, and, most importantly, timely interventions for high-risk neonates, ultimately saving lives in Ethiopia.
    Main findings: This prognosis risk score for neonatal mortality tested in Ethiopia had high performance accuracy and the decision curve analysis showed increased clinical utility performance.Added knowledge: The tool developed here can aid healthcare providers in identifying high-risk neonates and making timely clinical decisions to save lives.Global health impact for policy and action: The findings have the potential to be applied in local contexts to identify high-risk neonates and make treatment decisions that could improve child survival rates.
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  • 文章类型: Journal Article
    妊娠期糖尿病(GDM)是一个重要的健康问题,因为它对母亲和胎儿都有不良影响。这种疾病病理的一个重要因素是肠道微生物群,这似乎对GDM的发展和进程产生了影响。肠道微生物群对产妇生殖健康的作用以及在怀孕期间以及在新生儿期发生的所有变化都引起了极大的兴趣。肠道微生物群的正确建立和成熟对于基本生物系统的发展非常重要。这项研究的目的是提供有关GDM对新生儿肠道菌群影响的文献的系统综述。以及与GDM母亲所生的新生儿的发病率和死亡率的可能联系。在包括PubMed和Scopus在内的数据库中进行了系统研究,直到2024年6月。涉及人口统计的数据,方法论,根据暴露于或患有GDM的患者得出并划分微生物群的变化。在在线数据库上进行的研究显示了316项研究,其中只有16符合所有标准,并被纳入本次审查。研究表明,在门的α和β多样性以及富集或耗尽的变化水平上,存在很大的异质性和不同的发现,基因,物种,以及GDM母亲所生的婴儿的新生儿肠道菌群中的操作分类单位。新生儿和婴儿的微生物群由于GDM而改变的方式仍不清楚,需要进一步研究。需要进一步的研究来探索和阐明这些机制。
    Gestational diabetes mellitus (GDM) is an important health issue, as it is connected with adverse effects to the mother as well as the fetus. A factor of essence for the pathology of this disorder is the gut microbiota, which seems to have an impact on the development and course of GDM. The role of the gut microbiota on maternal reproductive health and all the changes that happen during pregnancy as well as during the neonatal period is of high interest. The correct establishment and maturation of the gut microbiota is of high importance for the development of basic biological systems. The aim of this study is to provide a systematic review of the literature on the effect of GDM on the gut microbiota of neonates, as well as possible links to morbidity and mortality of neonates born to mothers with GDM. Systematic research took place in databases including PubMed and Scopus until June 2024. Data that involved demographics, methodology, and changes to the microbiota were derived and divided based on patients with exposure to or with GDM. The research conducted on online databases revealed 316 studies, of which only 16 met all the criteria and were included in this review. Research from the studies showed great heterogeneity and varying findings at the level of changes in α and β diversity and enrichment or depletion in phylum, gene, species, and operational taxonomic units in the neonatal gut microbiota of infants born to mothers with GDM. The ways in which the microbiota of neonates and infants are altered due to GDM remain largely unclear and require further investigation. Future studies are needed to explore and clarify these mechanisms.
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  • 文章类型: Journal Article
    狗的寄生虫感染很频繁,特别是在繁殖狗窝中,是造成动物痛苦和育种者经济损失的原因。在繁殖母狗时,一些寄生虫可能会导致流产,在幼犬中,它们可能是新生儿死亡的原因,断奶腹泻,或神经系统的临床症状.这篇综述旨在探讨易感因素,诊断,与繁殖犬舍中最常见的寄生虫病有关的控制。它突出表明,在种群水平上控制狗的寄生虫病是复杂的。因此,需要一种全面的多学科和多技术方法来处理内寄生虫。
    Parasitic infestations in dogs are frequent, particularly in breeding kennels, being a cause of suffering in animals and economic loss for breeders. In breeding bitches, some parasites may cause abortion, and in puppies they may be responsible for neonatal mortality, weaning diarrhea, or neurological clinical signs. This review aims to investigate the factors of predisposition, diagnostics, and control in relation to the most frequent parasitic diseases in breeding kennels. It highlights that the control of parasitic diseases in dogs at the population level is complex. A holistic multidisciplinary and pluritechnical approach is thus needed to deal with endoparasitoses.
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  • 文章类型: Journal Article
    本研究旨在分析过去十年(2013-2023年)新生儿死亡率的决定因素。确定在COVID-19大流行之前和期间影响新生儿结局的关键因素。利用以PRISMA方法为指导的系统文献综述方法,这项研究评估了从Scopus等索引数据库收集的91篇论文,PubMed,和WebofScience。该审查涵盖了全球范围内进行的研究,提供有关新生儿死亡率研究的演变以及COVID-19危机对新生儿健康的影响的见解。分析揭示了一系列复杂的风险决定因素,分为社会经济因素,临床因素,以及医疗保健和质量。值得注意的因素包括农村和城市的医疗保健差距,产前和产后护理质量,以及医疗基础设施对新生儿结局的影响。这项研究强调了应对全球健康挑战的新生儿死亡率研究的重点转移。包括大流行。研究结果强调了需要多学科方法来解决新生儿死亡率,强调加强医疗系统的重要性,改善孕产妇教育,并确保公平获得优质护理。未来的研究应该探讨COVID-19大流行对新生儿健康的长期影响,并调查不同医疗机构中干预措施的有效性。
    This study aimed to analyze the determinants of neonatal mortality over the last decade (2013-2023), identifying key factors that have influenced neonatal outcomes both before and during the COVID-19 pandemic. Utilizing a systematic literature review approach guided by the PRISMA method, this study evaluates 91 papers collected from indexed databases such as Scopus, PubMed, and Web of Science. The review encompasses studies conducted globally, offering insights into the evolution of neonatal mortality research and the impact of the COVID-19 crisis on neonatal health. The analysis revealed a complex array of risk determinants, categorized into socioeconomic factors, clinical factors, and healthcare access and quality. Notable factors include rural versus urban healthcare disparities, prenatal and postnatal care quality, and the influence of healthcare infrastructure on neonatal outcomes. This study highlights the shifting focus of neonatal mortality research in response to global health challenges, including the pandemic. The findings underscore the need for multidisciplinary approaches to address neonatal mortality, emphasizing the importance of enhancing healthcare systems, improving maternal education, and ensuring equitable access to quality care. Future research should explore the long-term effects of the COVID-19 pandemic on neonatal health and investigate the efficacy of interventions in diverse healthcare settings.
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  • 文章类型: Journal Article
    背景:在加拿大,新生儿发病率远远超过死亡率。新生儿不良结局指标(NAOI)总结新生儿发病率,但加拿大缺乏趋势数据。
    方法:这项加拿大范围的回顾性横断面研究包括妊娠24至42周的住院分娩,从2013年到2022年。数据来自加拿大健康信息研究所的出院摘要数据库,不包括魁北克。NAOI包括15种新生儿并发症(例如,出生创伤,脑室内出血,或呼吸衰竭)和七种干预措施(例如,通过插管和/或胸部按压进行复苏),改编自澳大利亚的NAOI。NAOI率按胎龄计算。计算新生儿死亡率的未调整比率(RR)和95%置信区间(CI)。新生儿重症监护病房(NICU)入院,延长住院时间,每个与存在的NAOI组分的数量相关(0、1、2、3、4或≥5)。
    结果:在2,821,671名新生儿中,NAOI率为7.6%。NAOI从2013年的7.3%增加到2022年的8.0%(p<0.01)。大多数早产儿的NAOI患病率最高。与没有NAOI相比,死亡率的RR(95%CI)为8.5(7.6-9.5),其中1,118.1(108.4-128.4),3和395.3(367.2-425.0),其中≥5个NAOI成分。NICU入院的RRS分别为6.7(6.6-6.7),11.2(10.9-11.3),和11.9(11.6-12.2),延长住院时间的RR为6.6(6.4-6.7),12.2(11.7-12.7),和26.4(25.2-27.5)。国际比较表明,加拿大的NAOI患病率较高。
    结论:加拿大NAOI使用住院数据捕获新生儿发病率,并与新生儿死亡率相关,NICU入院,和延长住院时间。近年来,新生儿发病率可能呈上升趋势。
    BACKGROUND: In Canada, newborn morbidity far surpasses mortality. The neonatal adverse outcome indicator (NAOI) summarizes neonatal morbidity, but Canadian trend data are lacking.
    METHODS: This Canada-wide retrospective cross-sectional study included hospital livebirths between 24 and 42 weeks\' gestation, from 2013 to 2022. Data were obtained from the Canadian Institute of Health Information\'s Discharge Abstract Database, excluding Quebec. The NAOI included 15 newborn complications (e.g., birth trauma, intraventricular hemorrhage, or respiratory failure) and seven interventions (e.g., resuscitation by intubation and/or chest compressions), adapted from Australia\'s NAOI. Rates of NAOI were calculated by gestational age. Unadjusted rate ratios (RR) and 95% confidence interval (CI) were calculated for neonatal mortality, neonatal intensive care unit (NICU) admission, and extended hospital stay, each in relation to the number of NAOI components present (0, 1, 2, 3, 4, or ≥5).
    RESULTS: Among 2,821,671 newborns, the NAOI rate was 7.6%. NAOI increased from 7.3% in 2013 to 8.0% in 2022 (p < 0.01). NAOI prevalence was highest in the most preterm infants. Compared to no NAOI, RRs (95% CI) for mortality were 8.5 (7.6-9.5) with 1, 118.1 (108.4-128.4) with 3, and 395.3 (367.2-425.0) with ≥5 NAOI components. Respective RRs for NICU admission were 6.7 (6.6-6.7), 11.2 (10.9-11.3), and 11.9 (11.6-12.2), and RR for extended hospital stay were 6.6 (6.4-6.7), 12.2 (11.7-12.7), and 26.4 (25.2-27.5). International comparison suggested that Canada had a higher prevalence of NAOI.
    CONCLUSIONS: The Canadian NAOI captures neonatal morbidity using hospitalization data and is associated with neonatal mortality, NICU admission, and extended hospital stay. Newborn morbidity may be on the rise in recent years.
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  • 文章类型: Journal Article
    背景:这篇多中心病例系列扩展综述的目的是描述胎盘和脐带异常的产前超声特征和致病机制及其与不良围产期结局的关系。从教育的角度来看,病例系列分为三部分;第1部分致力于胎盘异常。
    方法:多中心病例系列妇女接受常规和延长的产前超声和围产期产科护理。
    结果:产前超声检查结果,围产期保健,并提供了胎盘病理病例的病理文件。
    结论:我们的病例系列回顾和医学文献证实了胎盘异常在可能危害胎儿健康的多种产科疾病中的伦理病理学作用和参与。这些特定病理中的一些与不良围产期结局的高风险密切相关。
    BACKGROUND: The aim of this extended review of multicenter case series is to describe the prenatal ultrasound features and pathogenetic mechanisms underlying placental and umbilical cord anomalies and their relationship with adverse perinatal outcome. From an educational point of view, the case series has been divided in three parts; Part 1 is dedicated to placental abnormalities.
    METHODS: Multicenter case series of women undergoing routine and extended prenatal ultrasound and perinatal obstetric care.
    RESULTS: Prenatal ultrasound findings, perinatal care, and pathology documentation in cases of placental pathology are presented.
    CONCLUSIONS: Our case series review and that of the medical literature confirms the ethiopathogenetic role and involvement of placenta abnormalities in a wide variety of obstetrics diseases that may jeopardize the fetal well-being. Some of these specific pathologies are strongly associated with a high risk of poor perinatal outcome.
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  • 文章类型: Journal Article
    这篇综述的主要目的是评估预防贫血的障碍,以及贫血妇女对其状况的态度和行为。因为铁对神经发育至关重要,缺铁性贫血(IDA)占怀孕母亲贫血的大多数。在印度和其他发展中国家,贫血是一个严重的健康问题。超过一半的孕妇患有贫血。搜索策略在PubMed中进行。没有使用MeSH术语搜索的文章很少。母亲贫血与其后代贫血之间的强相关性表明代际贫血具有持久的后果。出生时体重不足和营养不良的儿童患贫血的风险更高。临床医生通常评估贫血,本简要综述概述了确定贫血原因的标准。
    This review\'s main objective was to assess the obstacles to anemia prevention, as well as the attitudes and behaviors of anemic women toward their condition. Since iron is crucial for neurodevelopment, iron deficiency anemia (IDA) accounts for the majority of pregnant mothers having anemia. In India and other developing countries, anemia is a serious health problem. More than half of pregnant women have anemia. The search strategy was conducted in PubMed. Few of the articles were searched without using MeSH terms. Strong correlations between mothers\' anemia and that of their offspring point to intergenerational anemia with lasting consequences. Children who were underweight at birth and those who were malnourished had a higher risk of having anemia. Clinicians usually evaluate anemia, and the criteria for determining the cause of anemia are outlined in this brief review.
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  • 文章类型: Journal Article
    考虑到解决新生儿死亡率问题对实现2030年可持续发展目标儿童健康的重要性,这方面的研究重点至关重要。尽管孟加拉国的新生儿死亡率(NMR)持续很高,仍然明显缺乏有力的证据来解决该国NMR的不平等。因此,这项研究旨在通过全面调查孟加拉国核磁共振中的不平等现象来填补知识空白。
    对2000年至2017年的孟加拉国人口与健康调查(BDHS)数据进行了分析。用来衡量不平等的公平分层是财富状况,母亲的教育,居住地,和国家以下地区。差异(D)和人口归因分数(PAF)是绝对度量,而人口归因风险(PAR)和比率(R)是不平等的相对衡量标准。通过估计每个估计值的95%置信区间(CI)来考虑统计学显著性。
    在孟加拉国发现NMR呈下降趋势,从2000年的50.2例死亡到2017年的31.9例死亡。这项研究检测到显著的财富驱动(PAF:-20.6,95%CI:-24.9,-16.3;PAR:-6.6,95%CI:-7.9,-5.2),教育相关(PAF:-11.6,95%CI:-13.4,-9.7;PAR:-3.7,95%CI:-4.3,-3.1),和区域(PAF:-20.6,95%CI:-27.0,-14.3;PAR:-6.6,95%CI:-8.6,-4.6)在所有测量点的NMR差异。我们还发现,2000年至2014年,除2017年外,城乡不平等现象明显。在NMR中观察到绝对和相对不等式;然而,这些不平等随着时间的推移而减少。
    孟加拉国各分组的NMR差异显着突出了全面,有针对性的干预措施。通过改善获得经济资源和教育的机会来增强妇女的权能可能有助于解决孟加拉国核磁共振的差距。未来的研究和政策应侧重于制定战略,以解决这些差距,并促进所有新生儿的公平健康结果。
    UNASSIGNED: Given the significance of addressing neonatal mortality in pursuing the 2030 Sustainable Development Goal on child health, research focus on this area is crucial. Despite the persistent high rates of neonatal mortality rate (NMR) in Bangladesh, there remains a notable lack of robust evidence addressing inequalities in NMR in the country. Therefore, this study aims to fill the knowledge gap by comprehensively investigating inequalities in NMR in Bangladesh.
    UNASSIGNED: The Bangladesh Demographic and Health Survey (BDHS) data from 2000 to 2017 were analyzed. The equity stratifiers used to measure the inequalities were wealth status, mother\'s education, place of residence, and subnational region. Difference (D) and population attributable fraction (PAF) were absolute measures, whereas population attributable risk (PAR) and ratio (R) were relative measures of inequality. Statistical significance was considered by estimating 95% confidence intervals (CIs) for each estimate.
    UNASSIGNED: A declining trend in NMR was found in Bangladesh, from 50.2 in 2000 to 31.9 deaths per 1000 live births in 2017. This study detected significant wealth-driven (PAF: -20.6, 95% CI: -24.9, -16.3; PAR: -6.6, 95% CI: -7.9, -5.2), education-related (PAF: -11.6, 95% CI: -13.4, -9.7; PAR: -3.7, 95% CI: -4.3, -3.1), and regional (PAF: -20.6, 95% CI: -27.0, -14.3; PAR: -6.6, 95% CI: -8.6, -4.6) disparities in NMR in all survey points. We also found a significant urban-rural inequality from 2000 to 2014, except in 2017. Both absolute and relative inequalities in NMR were observed; however, these inequalities decreased over time.
    UNASSIGNED: Significant variations in NMR across subgroups in Bangladesh highlight the need for comprehensive, and targeted interventions. Empowering women through improved access to economic resources and education may help address disparities in NMR in Bangladesh. Future research and policies should focus on developing strategies to address these disparities and promote equitable health outcomes for all newborns.
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  • 文章类型: Journal Article
    背景/目标:早产率仍然很高,对任何国家的公共卫生系统都是挑战,对新生儿死亡率有很大影响。本研究旨在评估一组产妇早产的频率和环境及母婴危险因素。他们的新生儿在一家私人参考医院的新生儿重症监护室接受监测。方法:在2013年至2018年期间,对居住在巴西东北部首都城市的产妇进行了队列研究,这些产妇的新生儿被送往新生儿重症监护病房。本研究得到福塔莱萨大学研究伦理委员会的批准。收集的信息包括来自医疗记录的数据和来自孕产妇家庭的水文卫生数据。结果:2013年至2018年,该医院活产(n=9778)的早产患病率为23%。符合条件的人(n=480)的早产频率为76.9%,在此期间,符合条件的早产儿(n=369)占分娩总数的频率为3.8%。在多变量分析中,早产的重要危险因素是初产妇(RR=1.104,95CI:1.004-1.213)和妊娠期高血压综合征(RR=1.262,95CI:1.161-1.371),且显著的保护因素是产前咨询次数最高(RR=0.924,95CI:0.901-0.947)。结论:这项研究有助于提高产前护理的知名度,以及对怀孕和分娩护理期间并发症的了解。这些结果表明,需要实施公共政策,促进改善人口的生活条件和照顾孕妇,以减少早产,因此,新生儿和婴儿死亡率。
    Background/Objectives: Prematurity rates remain high and represent a challenge for the public health systems of any country, with a high impact on neonatal mortality. This study aimed to evaluate the frequency and environmental and maternal-fetal risk factors for premature birth in a cohort of parturient women, with their newborns monitored in a neonatal intensive care unit at a private reference hospital. Methods: A cohort was carried out between 2013 and 2018 among parturient women living in a capital city in the Northeast of Brazil whose newborns were admitted to the neonatal intensive care unit. This study was approved by the Research Ethics Committee of the University of Fortaleza. The information collected comprised data from both medical records and hydrosanitary data from maternal homes. Results: The prevalence of prematurity among live births (n = 9778) between 2013 and 2018 at this hospital was 23%. The frequency of prematurity among those eligible (n = 480) was 76.9%, and the frequency of eligible premature babies (n = 369) in relation to the total number of births in this period was 3.8%. In the multivariate analysis, the significant risk factors for prematurity were primigravida (RR = 1.104, 95%CI: 1.004-1.213) and hypertensive syndromes during pregnancy (RR = 1.262, 95%CI: 1.161-1.371), and the significant protective factor was the highest number of prenatal consultations (RR = 0.924, 95%CI: 0.901-0.947). Conclusions: This study contributes to providing greater visibility to prenatal care and the understanding of complications during pregnancy and childbirth care. These results indicate the need to implement public policies that promote improvements in the population\'s living conditions and care for pregnant women to reduce premature births and, consequently, neonatal and infant mortality.
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  • 文章类型: Journal Article
    背景:死胎是一个主要的全球健康问题。一半的死胎发生在产时期间,主要在撒哈拉以南非洲和南亚的低收入和中等收入国家。到2030年实现每千名新生儿中不到12例的死胎率是每个新生儿行动计划和可持续发展目标的全球目标。有证据表明,提高产时护理质量可以帮助减少死胎和其他不良妊娠结局。这项研究将探讨产时护理点的质量改善(QI)包是否可以减少死胎和其他结果,例如孕产妇和新生儿死亡率。
    方法:我们将进行系统的文献综述和荟萃分析。将为PubMed数据库制定全面的搜索策略,WebofScience,ScienceDirect,ProQuest,科克伦与中国国家知识基础设施。我们将包括随机对照试验,非随机对照试验,对照临床试验,中断的时间序列,队列研究,病例对照和巢式病例对照研究,评估产时护理点QI干预对死胎和其他不良妊娠结局的影响。我们将搜索灰色文献,如未发表的研究报告,论文和未完成的试验。将包括英语和非英语语言文章,以避免语言偏见。我们还将评估报告质量和偏差风险。将对异质性进行敏感性测试。将使用随机效应模型计算效应大小的集合估计。将用定性叙事合成补充定量合成,如果认为有必要。我们将使用漏斗图和Egger的回归检验来探索出版偏差,如果需要。
    结论:我们将报告跨多个环境的不同产时QI干预措施在避免死产和其他不良结局如孕产妇死亡率和新生儿死亡率方面的综合有效性。
    BACKGROUND: Stillbirths are a major global health concern. Half of stillbirths occur during intrapartum period, mostly in low- and middle-income countries of sub-Saharan Africa and South Asia. Achieving a stillbirth rate of less than 12 per 1000 births by 2030 is the global target of Every Newborn Action Plan and Sustainable Development Goals. Evidence suggests that improving intrapartum quality of care can help reduce stillbirths and other adverse pregnancy outcomes. This study will explore whether quality improvement (QI) packages at intrapartum care points can reduce stillbirths and other outcomes such as maternal and neonatal mortality.
    METHODS: We will conduct a systematic literature review and meta-analysis. Comprehensive search strategy will be developed for databases PubMed, Web of Science, ScienceDirect, ProQuest, Cochrane and China National Knowledge Infrastructure. We will include randomized controlled trials, controlled non-randomized trials, controlled clinical trials, interrupted time series, cohort studies, case-control and nested case-control studies which assess the impact of QI interventions at intrapartum points of care on stillbirths and other adverse pregnancy outcomes. We will search grey literature such as unpublished research studies, dissertations and unfinished trials. English and non-English language articles will be included to avoid language bias. We will also evaluate reporting quality and risk of bias. Sensitivity tests will be carried out for heterogeneity. Pooled estimates of effect sizes will be computed with random-effects models. Supplementation of the quantitative synthesis with a qualitative narrative synthesis would be added, if deemed necessary. We will explore publication bias using funnel plot and Egger\'s regression test will be used for evaluation, if needed.
    CONCLUSIONS: We will report pooled effectiveness of different intrapartum QI interventions across multiple settings in averting stillbirths and other adverse outcomes such as maternal mortality and neonatal mortality.
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